Anesthesia issues

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124 papers 1000+ followers
By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
I Ahmad, K El-Boghdadly, R Bhagrath, I Hodzovic, A F McNarry, F Mir, E P O'Sullivan, A Patel, M Stacey, D Vaughan
Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high-quality evidence, expert consensus and a Delphi study were used to formulate recommendations...
November 14, 2019: Anaesthesia
T Yu, B Wang, X J Jin, R R Wu, H Wu, J J He, W D Yao, Y H Li
BACKGROUND: The goal of this study was to assess the value of the 3-3 rule and the 3-3-1 rule in predicting difficult airways. METHODS: The authors conducted an observational study over a 6-month period. For each consenting adult patient undergoing general anesthesia, preoperative patient characteristics and data regarding difficult airway assessments and airway outcomes were collected. The 3-3-2 rule, 3-3-1 rule and 3-3 rule were included in preoperative difficult airway assessments...
September 2015: Irish Journal of Medical Science
D Cattano, P V Killoran, D Iannucci, V Maddukuri, A V Altamirano, S Sridhar, C Seitan, Z Chen, C A Hagberg
BACKGROUND: Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration. METHODS: After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery...
August 2013: British Journal of Anaesthesia
Edward Kuzmack, Travis Inglis, David Olvera, Allen Wolfe, Kona Seng, Daniel Davis
BACKGROUND: Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients. OBJECTIVE: To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort...
April 2018: Journal of Emergency Medicine
Jean-Luc Hanouz, Vincent Bonnet, Clément Buléon, Thérèse Simonet, Dorothée Radenac, Guillaume Zamparini, Marc Olivier Fischer, Jean-Louis Gérard
BACKGROUND: The Mallampati classification (MLPT) is normally evaluated in the sitting position. However, many patients cannot be evaluated in the sitting position for medical reasons. Thus, we compared the MLPT in sitting and supine positions in predicting difficult tracheal intubation (DTI). We hypothesized that the diagnostic accuracy of the MLPT performed in sitting and supine positions would differ. METHODS: We performed a single-center prospective observational study in adult patients who received general anesthesia and orotracheal intubation for noncardiac surgery...
January 2018: Anesthesia and Analgesia
D W Healy, E J LaHart, E E Peoples, E S Jewell, R J Bettendorf, S K Ramachandran
BACKGROUND: The Mallampati examination is a standard component of an airway risk assessment. Existing evidence suggests that cervical spine extension improves the predictive power of the Mallampati examination for detecting difficult laryngoscopy and tracheal intubation, but a comparative effectiveness study has not been conducted. METHODS: The extended Mallampati examination (EMS) was introduced to the standard preoperative airway assessment, in addition to the standard Modified Mallampati examination (MMP)...
May 2016: British Journal of Anaesthesia
Paulo Sérgio Lucas da Silva, Marcelo Cunio Machado Fonseca, Simone Brasil Oliveira Iglesias, Emílio Lopes Junior, Vânia Euzébio de Aguiar, Werther Brunow de Carvalho
PURPOSE: Nebulized L-epinephrine has been recommended for the treatment of viral croup. However, the few studies assessing its effect on post-extubation stridor (PES) have shown conflicting results. We compared the efficacy and safety of nebulized L-epinephrine at three different doses for the treatment of PES. PATIENTS AND METHODS: We conducted a prospective, randomized, double-blind trial including all consecutive children with a PES score of ≥4 (Westley score)...
February 2012: Intensive Care Medicine
Takashi Juri, Koichi Suehiro, Shigemune Kuwata, Sayaka Tsujimoto, Akira Mukai, Katsuaki Tanaka, Tokuhiro Yamada, Takashi Mori, Kiyonobu Nishikawa
PURPOSE: Hypotension and decreased cardiac output (CO) are common adverse effects during anesthesia induction depending on the patient's pre-anesthetic cardiac condition. The aim of this study was to assess the ability of hydroxyethyl starch (HES) 130/0.4 to prevent hypotension and decreased CO during the induction of general anesthesia. METHODS: Ninety patients undergoing laparoscopic surgery were randomly divided into a HES group and a crystalloid group. Following the insertion of an intravenous line, fluid was administered to each patient at a rate of 25 ml/min using either crystalloid or HES 130/0...
December 2017: Journal of Anesthesia
Siddharth Nath, Alex Koziarz, Jetan H Badhiwala, Waleed Alhazzani, Roman Jaeschke, Sunjay Sharma, Laura Banfield, Ashkan Shoamanesh, Sheila Singh, Farshad Nassiri, Wieslaw Oczkowski, Emilie Belley-Côté, Ray Truant, Kesava Reddy, Maureen O Meade, Forough Farrokhyar, Malgorzata M Bala, Fayez Alshamsi, Mette Krag, Itziar Etxeandia-Ikobaltzeta, Regina Kunz, Osamu Nishida, Charles Matouk, Magdy Selim, Andrew Rhodes, Gregory Hawryluk, Saleh A Almenawer
BACKGROUND: Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. METHODS: In this systematic review and meta-analysis, we independently searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomised controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication...
March 24, 2018: Lancet
Jon Lurie, Christy Tomkins-Lane
Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency...
January 4, 2016: BMJ: British Medical Journal
Laxmaiah Manchikanti, Nebojsa Nick Knezevic, Mark V Boswell, Alan D Kaye, Joshua A Hirsch
BACKGROUND: The prevalence of chronic low back pain and related disability is rapidly increasing as are the myriad treatments, including epidural injections. Even though epidural injections are one of the most commonly performed procedures in managing low back and lower extremity pain, starting in 1901 with local anesthetic alone, conflicting recommendations have been provided, despite the extensive literature. Recently Chou et al performed a technology assessment review for Agency for Healthcare Research and Quality (AHRQ) part of which was published in Annals of Internal Medicine showing lack of effectiveness of epidural steroid injections in managing lumbar radiculopathy and spinal stenosis...
March 2016: Pain Physician
N K Arden, C Price, I Reading, J Stubbing, J Hazelgrove, C Dunne, M Michel, P Rogers, C Cooper
OBJECTIVE: To determine the effectiveness and predictors of response to lumbar epidural corticosteroid injections (ESI) in patients with sciatica. We performed a 12-month, multicentre, double-blind, randomized, placebo-controlled, parallel-group trial in four secondary pain-care clinics in the Wessex Region. METHODS: Two hundred and twenty-eight patients with a clinical diagnosis of unilateral sciatica of 1-18 months' duration were randomized to either three lumbar ESIs of triamcinolone acetonide or interligamentous saline injections at intervals of 3 weeks...
November 2005: Rheumatology
Ippokratis Pountos, Michalis Panteli, Gavin Walters, Dudley Bush, Peter V Giannoudis
BACKGROUND AND OBJECTIVE: Epidural corticosteroid injections (ESIs) have been used for several decades and now represent the most common intervention performed for the management of back pain with a radicular component. However, several reports have presented devastating complications and adverse effects, which fuelled concerns over the risk versus clinical effectiveness. The authors offer a comprehensive review of the available literature and analyse the data derived from studies and case reports...
March 2016: Drugs in R&D
Una E Makris, Todd C Edwards, Danielle C Lavallee, Zoya Bauer, Bryan A Comstock, Jeffrey G Jarvik, Donald L Patrick, Mahshid Lotfi, Janna L Friedly
STUDY DESIGN: Secondary analysis of lumbar epidural steroid injections for spinal stenosis randomized controlled trial data. OBJECTIVE: To reevaluate whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items. SUMMARY OF BACKGROUND DATA: Epidural corticosteroid injections are commonly used to treat lumbar spinal stenosis symptoms, despite limited evidence for their effectiveness in clinical trials...
January 1, 2017: Spine
George C Chang Chien, Zack McCormick, Marco Araujo, Kenneth D Candido
Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia...
May 2014: Pain Physician
Sebastián Flores, Marcelo Molina
There are several nonsurgical alternatives to treat radicular pain in degenerative lumbar spinal stenosis. Epidural steroid injections have been used for several decades, but the different studies have shown variable effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified nine systematic reviews including seven pertinent randomized controlled trials. We concluded epidural steroid injection probably leads to little or no effect on reducing radicular pain of spinal stenosis...
November 16, 2015: Medwave
R S Vela Vásquez, R Peláez Romero
The safety of aspirin therapy in neuraxial anaesthesia has been historically questioned, and the current recommendations are still heterogeneous. A comprehensive review of clinical evidence and a comparative analysis of European and American guidelines were performed. Low-dose aspirin produces a selective, complete and irreversible cyclooxygenase-1 blockade, and higher doses do not increase the antiplatelet effect. Additional cyclooxygenase-2 blockade by high-dose aspirin might decrease the antithrombotic efficacy by inhibiting endothelial prostacyclin synthesis...
November 2015: British Journal of Anaesthesia
Matthew T V Chan, Mandy H M Chu, Carmen K M Lam, Bo Jia, Sharon Tsang, William K K Wu
No abstract text is available yet for this article.
June 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Ann Misun Youn, Tzung-Min Hsu
BACKGROUND: Propofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain. METHODS: A randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II...
February 2017: Korean Journal of Anesthesiology
Anahi Perlas, Liisa Davis, Masood Khan, Nicholas Mitsakakis, Vincent W S Chan
BACKGROUND: Aspiration pneumonia remains a serious anesthetic-related complication. A reliable diagnostic tool to assess gastric volume is currently lacking. We recently demonstrated that gastric sonography can provide reliable qualitative and quantitative information about gastric content and volume in healthy volunteers. In the current study, we performed a prospective qualitative and quantitative analysis of the gastric antrum in 200 fasted patients undergoing elective surgery. METHODS: A standardized gastric scanning protocol was applied before anesthetic induction...
July 2011: Anesthesia and Analgesia
2017-01-10 19:06:47
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